Project Summary Child maltreatment (CM) is a major public health problem, affecting many lives, in the short-and long-term, and costing individuals, families and society dearly. The Healthy People Goals 2020 call for reducing fatal and nonfatal CM. Achieving this hinges on broad implementation of effective, evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents, and thereby promote children?s health, development and safety, help prevent CM, and benefit the health of the US population. The proposed research focuses on examining intervention strategies aimed at optimizing SEEK?s adoption, implementation and sustainment and their effectiveness in helping prevent CM. Despite the strong supporting evidence from two large federally-funded randomized controlled trials, SEEK has not been widely adopted. The overarching goal of the proposed study is examine two technology driven implementation strategies to scale-up SEEK - in pediatric and family medicine primary care settings. As in withPAR-16-238, this proposal targets ?strategies to implement health promotion, prevention, screening, early detection, and diagnostic interventions, as well as effective treatments, clinical procedures, or guidelines into existing care systems? through these aims: 1) Evaluate the effectiveness of targeted implementation strategies on the implementation of SEEK in primary care settings; 2) Evaluate barriers and facilitators to successful service start-up and sustainment of SEEK; and 3) Examine effectiveness in preventing CM. This randomized Type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK?s adoption and implementation. Leveraging a commitment by 5 major healthcare systems serving diverse populations across the US, we have a valuable opportunity to evaluate key training approaches increasingly common in medical education ? independent online training (IND) and in-depth structured training via a Maintenance of Certification Quality Improvement (QI) project, approved by the American Boards of Pediatrics and of Family Medicine (MOC-4). In addition, we will evaluate SEEKonline, software that assists busy primary care practitioners (PCPs) implement the model, with fidelity. This will be compared to a ?Traditional? paper and pencil strategy in terms of their impact on implementation and in preventing CM. We will also assess the economic costs associated with implementing SEEK, a very promising approach for helping prevent children from being abused and neglected, and the many sequelae. The knowledge gained should improve pediatric primary care to better address prevalent psychosocial problems and benefit children and their families. The outcomes should also help build the field of implementation science, and guide future interventions addressing social determinants of child health.